- Participating Physician Groups (PPG)
Health Net partners with ModivCare™ (formerly LogistiCare) to provide non-emergency medical transportation (NEMT) and non-medical transportation (NMT) services to Health Net members enrolled in the Cal MediConnect Plan.
Health Net is responsible for NMT to services that are carved-out, including dental services.
NMT includes transportation for medically necessary appointments and may be provided by taxi, sedans, paratransit such as Access, or fixed route transportation such as buses. The NMT supplemental transportation benefit consists of:
- San Diego County: unlimited trips; Los Angeles County: unlimited trips, per member per calendar year with no charge.
- Curb-to-curb or door-to-door service (depending on the member's needs).
- Taxi, standard passenger vehicle or minivan.
- Service to and from medical appointments.
- No limitation on mileage within the service area.
- Inclusion of one family member or caretaker on the transport at no additional cost.
NMT services include: round-trip transportation for a member by passenger car or taxicab.
Round-trip NMT is available for the following:
- medically necessary covered services
- members picking up drug prescriptions that cannot be mailed directly to the member
- members picking up medical supplies, prosthetics, orthotics, and other equipment
- dental services
- mental health services
- substance abuse services
Non-Emergency Medical Transportation
NEMT includes ambulance, wheelchair and gurney vans, and is provided when medically necessary and the member is not ambulatory. NEMT under Cal MediConnect is covered only when a member's medical and physical condition does not allow the member to travel by bus, passenger car, taxicab, or another form of public or private conveyance. Transport is not covered if the care to be obtained is not a Cal MediConnect benefit. NEMT necessary to obtain medical services is covered subject to the written prescription of a physician, dentist or a podiatrist.
To request transportation services described above, members can be directed to call ModivCare, or when calling the Cal MediConnect Member Services Department, they may choose the transportation prompt, which will transfer their call to ModivCare.
Use the Physician Certification Statement (PCS) form (PDF) to document the specific transportation restrictions of an enrollee due to a medical condition, and request non-emergency medical transportation (NEMT) for Cal MediConnect enrollees. A PCS form is not required for non-medical transportation (NMT).
Providers who may complete and sign the PCS form include:
- Participating physician group (PPG) or independent practice association (IPA)
- Doctor of medicine (MD)
- Registered nurse (RN)
- Nurse practitioner (NP)
- Primary care physician (PCP)
- Licensed vocational nurse (LVN)
- Physician assistant (PA)
- Certified midwife
- Discharge planner employed or supervised by the hospital, facility or physician’s office where the patient is being treated, and has knowledge of the patient’s condition when completing the form.